best practices for emergency shelter providers
TRANSCRIPT
8/31/20
Best Practices for Emergency Shelter Providers
Introductions
HomeBase has been working with Continuums of Care and homeless service providers throughout the country for three decades on eradicating homelessness.
We help CoCs design and implementHousing First, Coordinated Entry, and other major system changes.
Agenda
• Permanent Housing: The Solution to Homelessness
• Problem-Solving Techniques
• Case Management Tools to Help Get Clients into Housing
What is the Solution to Homelessness?
The Solution to Homelessness
• Getting people into housing.
• As emergency shelter providers this should be the primary goal.
Housing First is an approach where homeless persons are provided immediate access to housing and then offered the supportive services that may be needed
to foster long-term stability and prevent a return to homelessness. This approach removes unnecessary barriers and assumes that supportive services are more
effective in addressing needs when the individual or family is housed – when the
daily stress of being homeless is taken out of the equation.
Ann Marie OlivaDirector, Office of Special Needs Assistance Programs
August 21, 2016
HUD Definition of Housing First
Housing First: What does a Housing First System Look Like?
• All programs lower barriers – shelter, services, and housing
• Most vulnerable – including those with complex service needs, disabilities, mental health and active substance abuse issues –prioritized for and admitted to shelter and housing programs
• Housing-focused services and engagement begin immediately –on the street and in shelters
• Services are client-focused and voluntary and targeted to individual needs
• Programs engage in evidence-based practices: harm-reduction, trauma-informed care, motivational interviewing, and other evidence-based approaches
• Client choice and voice are engaged and respected
Housing First Programs Get People into Housing
Aligning your program with Housing First principles will help eliminate barriers get people into housing as quickly as possible
What approach you use to get people into permanent housing may need to be adjusted based on the person or
household you are serving.
Who is Experiencing Homelessness
• National data shows that a majority of people experiencing homelessness are transitionally homeless.
• Transitionally homeless means that they are homeless once in their lives for a week or two and are never homeless again.
• Monterey 2019 PIT Count Showed:
• 2,422 (people experiencing homelessness)
• 1,830 (unsheltered)
• 562 (chronically homeless) – 483 unsheltered
Can the ‘System’ House Everyone?
• There are too few housing resources for everyone experiencing homelessness – and they are primarily aimed at high-acuity people through coordinated entry
• For people who are low-acuity and/or transitionally homeless waiting for a unit (that may never come) through coordinated entry is not the most effective strategy
• It is vital to identify housing resources outside of the system of care/coordinated entry that people can access before they enter homelessness or to quickly exit from homelessness
Problem Solving
Problem solving is essentially a conversational technique and resource identification process that helps providers work with the client to identify alternatives to entering homelessness or rapid exits from the homelessness system of care.
The Problem-Solving Conversation: Where, When, Who and How Long?
• Where: Begins at the “front door” to homeless services - Coordinated Entry intake; Emergency shelter; Street Outreach; Implemented anywheresomeone is seeking assistance related to a housing crisis
• When: At any point in that crisis
• Who: Offered to all households at point of entry into homeless services system, regardless of perceived needs and barriers. No pre-screening or pre-determination.
• How Long: Strategies continue until the household is safely and permanently housed – not a one-time conversation.
Problem Solving for Prevention, Diversion, or Rapid Exit
• When a Person is Still Housed – Prevention: Activities that target assistance to prevent housing crises that do occur from escalating further and resulting in homelessness.
• Before Entering Shelter - Diversion: Diversion strategies and practices assist people to resolve their immediate housing crisis by accessing alternatives to entering emergency shelter or the experience of unsheltered living.
• After Entering Shelter - Rapid Exit: Rapid exit strategies are appropriate after a household has entered emergency shelter or stayed in an unsheltered setting and serves to help them move as quickly as possible back into housing with the support of services and a minimal level of financial assistance. Providers should initiate problem-solving conversations to identify housing opportunities that clients may already have access to.
Desired Outcomes
Permanently back with family
or friends
Return to their own residence
Temporarily diverted while they seek new
housing
Relocating permanently to
a safe place out of town
Reconnecting to supports who
can provide care
Basic Concept
Have supportive conversations with people to help them identify housing resources that already exist.
Most people will not get housing through coordinated entry and some people do not need those resources.
Problem-Solving Conversations
• Start at Front Door: Offer problem solving to all households without pre-screening using staff trained in available local supports
• Introduce Goals: Clearly explain role and goal to help identify a safe space to stay, either temporarily or permanently, and community connections that will help avoid or exit homelessness
• Explore Needs and Options: Have a realistic conversation about household’s strengths, supports, and possibilities
• Listen Actively: Validate and acknowledge household’s ideas, feelings and efforts and support them in finding solutions
How to Start the Conversation
•Engage with the Person
• Introduce yourself
•Check-in (how are you doing?)
•Connect
•Then start collecting information
How to Start the Conversation
• What is your name and what brings you here?
• Where did you sleep last night?
• When was the last time you were stably housed?
• What issues exist with you previous or most recent housing situations. Can those be resolved with financial assistance? Other assistance? (Case management, mediation, legal counseling etc.)
• What other housing options do you have for the next few days or weeks?
• Do you have family or friends who you could stay with? What resources could this become a permanent solution? (Financial assistance, case management, mediation, legal counseling etc.)
Core Knowledge for Staff Problem Solvers
Skill Building Training
• Motivational Interviewing• Cultural Humility and
Curiosity • Diversion and Prevention• Conflict Resolution• Restorative Justice models• Trauma-Informed Care,
including understanding poverty and homelessness as trauma
• Domestic Violence
Public Systems Navigation Training
• Public Benefits• Mental Health Services• Employment Services• Legal Advocacy Groups• Education• Senior Services• Affordable Housing
Training Staff to Problem-Solve
• No short-cut tool – the tool is the conversation
• Conversation based on the belief that you can assist household to find a better alternative to shelter / homelessness
• Focus on techniques of effective, strengths-focused communication:
• Respect for client choice• Recognition of safety• Active listening• Awareness of communication roadblocks• Practice personal and cultural humility• Seek to balance power dynamics
Training Staff to Problem-Solve
Active Listening Skills
• Encouraging
• Clarifying
• Restating
• Reflecting
• Summarizing
• Validating
• Reframing / paraphrase and summarize
Training Staff to Problem-Solve
Active Listening Skills (cont.)
• Take time to listen
• Tune in to nonverbal cues & body language
• Build rapport, understanding and trust
• Open ended questions
• Relaxed and open
Training Staff to Problem-Solve
Awareness of Roadblocks to Communication
• Analyzing
• Lecturing*
• Interrogating
• Provoking Rebuttal
• Asking Yes or No Questions
• Judging
• Being aware of the space you are in and how that might change the dynamic and depth of conversation
• If you are taking notes understanding how that may impact client
Training Staff to Problem-Solve
Practice Personal and Cultural Humility/Curiosity
• Recognize similarities, differences & biases
• Acknowledge mutual humanity
• Excuse ourselves and others from unrealistic responsibility of needing to be “right” all the time
• Remain impartial
• Be sincere and genuine
• Be respectful
• Ask open-ended questions
• Do not Ass-u-me
• Don’t be afraid to speak directly about cultural differences
Creative Problem-Solving Solutions
• Assisting someone locate a family member or friend who can help
• Acting as a mediator in the current housing situation to develop a resolution that can allow the household to stay
• Resolving disputes with landlords or previous landlords
• One-time or short-term financial assistance for housing related costs such as:
• support with move-in costs
• resolving past due utility bills
• paying for household basic needs such as groceries
• Getting credit reports and identifying ways to clear debt / communicate the situation to landlords
• Begin expungement process if possible
• Connect with tenant legal services
Let’s Practice
• Lily presents at your shelter seeking assistance. She is 27 years old and has mental health and substance abuse issues.
• What should shelter staff do first?
• Ask Questions!!!!
• What is your name and what brings you here?
• Where did you stay last night/I understand you were staying at _____?
• Can you stay there tonight?
• Are there other places you have stayed in the past?
• Could you stay there tonight?
• What do you think it would take to be stably housed – what does that look like for you?
Let’s Practice
• After talking to Lily you identify that she was staying with an Aunt. The Aunt kicked her out because Lily was “using drugs and not contributing to the household” (not buying food, not cleaning etc.)
• What are some strategies or types of assistance that might help get Lily back into her Aunt’s house?
Let’s Practice
• Are there flex funds available?
• Could these funds be used to help Lily contribute to groceries for a few months and help her Aunt pay for a house cleaner?
• Would Lily qualify for IHSS? Could this help provide some ongoing support in the home?
• Can you connect Lily with other benefits that could help her assist with household payments (SSI?).
• Could you do some mediation between Lily and her Aunt to help her stay? (e.g. can you come up with a plan where Lily agrees for example not to do drugs in the home (only outside the home)?)
• Could you offer optional services to assist Lily in staying sober if that is what she wants?
Let’s Practice
• Is this an example of Diversion or Rapid Exit?
• It is an example of Diversion.
• Is this an important question?
• NO! Whether the client is entering the shelter or already staying there it is important to have problem solving conversations with everyone to facilitate identification of housing.
The Goal for Everyone is Housing
When problem solving is not initially successful, staff should continue to follow up on these conversations and ensure that the household is assessed with the community’s assessment tool (VI-SPDAT) and entered into the community queue for housing through coordinated entry.
Break
Time!!!
Using Case Management Tools to Get Clients into Housing
Case Management Tools
• Trauma Informed Care
•Motivational Interviewing
• Strengths-Based Approach
Providers should leverage these strategies to get people into permanent housing
Trauma-Informed Care
What is Trauma
Trauma is a deeply distressing or disturbing event that overwhelms an individual’s ability to
cope, causes feelings of helplessness, diminishes their sense of self and their ability to
feel the full range of emotions and experiences.
Trauma-Informed Care
• Trauma-Informed Care (TIC) is an overarching structure and treatment attitude that emphasizes understanding, compassion, and responding to the effects of all types of trauma.
• Becoming “trauma-informed” means recognizing that people have many different traumatic experiences which often intersect in their lives.
• Well-meaning services providers can often unintentionally re-traumatize clients who need understanding, support, and individually conscious care.
Core Components Trauma-Informed Care
Understanding Trauma and Its Impact
Promoting Safety
Ensuring Cultural Humility
Supporting Consumer Control, Choice and Autonomy
Sharing Power and Governance
Integrating Care
Healing Happens in Relationships
Recovery is Possible
Core Components Trauma Informed Care
What Does this Mean for You?
• When you meet with a client, consider trauma
• Don’t ask “What’s wrong with you?,” ask “What’s your story what brings you here, how can I help?”
• If a client becomes distressed or is resistant, don’t take it personally. Consider that perhaps the reaction is the result of past or current trauma
• Make shelter environment safe and welcoming
• Make provider responses predictable and respectful
What Does this Mean for You?
• Understanding how cultural context influences one’s perception of and response to traumatic events and the recovery process
• Empower participants by evoking information as opposed to providing information to them. Assist in filling in gaps in knowledge/information
• Understand that building positive relationships with clients is a core component of recovery
Making Shelters Trauma Informed
https://www.youtube.com/watch?v=5hauwKR-KIM
Motivational Interviewing
Motivational Interviewing
• Motivational interviewing is a patient-centered collaborative conversation style. Not a clinical method, anyone can use it.
• Motivation to change varies from person to person, from one situation to another, and over time.
• It is based on the premise that for a person to “grow,” we need an environment that provides us with genuine openness that enables self-disclosure, acceptance that includes being seen with unconditional positive regard, and empathy where we feel like we are being listened to and understood.
• People are better persuaded by the reasons they themselves discovered than those that come into the minds of others (Blaise Pascal).
Motivational Interviewing
• Motivational interviewing encourages people to think and talk about their reasons to change.
• Motivational interviewing accepts that ambivalence about change is a normal human experience and often a necessary step in the process of change.
• Motivational interviewing aims to encourage a person’s autonomy in decision making where the provider acts as a guide, clarifying a person’s strengths and aspirations, listening to their concerns, boosting their confidence in their ability to change, and eventually collaborating with them on a plan for change.
Spirit of Motivational Interviewing
• The spirit is the intention and foundation of your actions, questions, without it your words fall flat.
• Partnership: Demonstrating profound respect for the other; recognizing both parties’ expertise; “dancing” rather than “wrestling.”
• Acceptance: Prizing the other’s inherent worth and potential; providing accurate empathy; supporting autonomy; affirming strengths.
• Compassion: Coming alongside in a person’s suffering; actively promoting the other’s welfare; giving priority to the other’s needs.
• Evocation: Eliciting the person’s own knowledge, wisdom, strengths, and motivation.
The Flow of a Motivation Interview Conversation
• Engaging the process of establishing a mutually trusting and respectful helping relationship
• Focusing clarifying a particular goal or direction for change
• Evoking eliciting the person’s own motivation for a particular change
• Planning developing a specific change plan that the client is willing to implement
Motivational Interviewing Techniques
• Open-ended questions: Allows us to find out more about the client’s perspective and ideas about change
• Affirming: Commenting on client’s strengths and abilities
• Reflective listening: Summarizing what the client has said as a statement
Motivational Interviewing Techniques
• Rolling with Resistance: Adjusting to client resistance rather than opposing it directly
• Informing and Advising: A process of providing information to a person in ways consistent with the spirit of MI; promotes the mutually productive, effective, and respectful exchange of information between practitioner and the client
Motivational Interviewing Techniques
• All of these can elicit “change talk”
• Change talk is the client making statements that are in favor of change
• Case manager goal is to elicit change talk from the client in a collaborative fashion and avoid opposing it
• Goal is to help the client identify and resolve ambivalence so they can move forward
Examples of “Change Talk”
• I'll stop someday. (reflection: So, sounds like you might be interested in stopping and think you might be able to someday)
• I don't have a problem with therapy, just don't make me take pills. (reflection: Therapy has been helpful for you in the past, if conditions were right, you might even go back)
• I don't want to be here. (Reflection: You want a place of your own)
• I miss my shower, I used to listen to music in there every morning, drink coffee on the porch. (Reflection: getting a place of your own is very important to you so you can do the things you enjoy)
Rolling with Resistance
• One view of resistance is that a person is behaving defiantly.
• Another, perhaps more constructive, viewpoint is that resistance is a signal that the person views the situation differently.
• This requires you to understand the other person’s perspective and proceed from there.
• Resistance is a signal to you to change direction or listen more carefully. Resistance actually offers you an opportunity to respond in a new, perhaps surprising, way and to take advantage of the situation without being confrontational.
Rolling with Resistance Roleplay
https://www.youtube.com/watch?v=rgqrusY2MJI
What Did You Think?
•What did the provider do well?
•What could she have done better?
Motivational Interviewing
The curious paradox is that when I accept myself just as I am, then I can change.
- Carl Rodgers
Strengths-Based Approach
What do You See When You Look At this Picture?
Does Anything Change When You Look for Her Strengths?
Strengths-Based Approach
• Determined, strong
• Able to communicate what she wants
• She is well-taken care of (hair done, outfit, her picture is being taken)
• She is expressing developmentally appropriate emotions
• Feels safe enough to express her feelings
What is Strengths-Based Approach?
• The strengths-based philosophy holds the core belief that all individuals have strengths and resources
• The focus of the practice is on a person's skills, interests, and support systems. Its simple premise is to identify what is going well, to do more of it, and to build on it
Principles of Strength-Based Approach
• Everyone possesses a uniqueness that helps them evolve and move along their journey. These unique characteristics can be potential strengths or capabilities
• What receives attention or focus becomes what we (or the client) strive(s) for and eventually becomes a reality
• Be careful with your words and language. Our language creates our (and our client’s) reality
Principles of Strength-Based Approach
• Support others as authentically as you can
• The person or client is the story-teller of their own story
• Be collaborative. Be adaptive and value differences (Hammond, 2010)
Remember: People are trying to get their needs met.
Activity!!
• We will be putting you in break out groups of 5.
• One person should volunteer to discuss a particularly challenging client or person in their lives. Describe the client or person and your interactions with them.
• Have other folks in the group identify strengths that the client or person has and discuss how you could leverage those strengths to see progress towards housing.
